Military Institute of Medicine, Ul. Szaserów 128, 04-141, Warsaw, Poland.
Maria Sklodowska-Curie Memorial Oncology Center and Institute of Oncology, Warsaw, Poland.
Clin Transl Oncol. 2018 Feb;20(2):150-159. doi: 10.1007/s12094-017-1703-5. Epub 2017 Jun 14.
A recent randomized trial (NCT01535209) demonstrated no difference in neurocognitive function between stereotactic radiotherapy of the tumor bed (SRT-TB) and whole brain radiotherapy (WBRT) in patients with resected single brain metastasis. Patients treated with SRT-TB had lower overall survival compared with the WBRT arm. Here, we compared the health-related quality of life (HRQOL) in patients who received WBRT vs. SRT-TB.
A self-reported questionnaire was used to assess HRQOL (EORTC QLQ-C30 with the QLQ-BN20 module) before RT, 2 months after RT, and every 3 months thereafter. HRQOL results are presented as mean scores and compared between groups.
Of 59 randomized patients, 37 (64%) were eligible for HRQOL analysis, 15 received SRT-TB, and 22 had WBRT. There were no differences between groups in global health status and main function scales/symptoms (except for drowsiness and appetite loss, which were worse with WBRT 2 months after RT). Global health status decreased 2 and 5 months after RT, but significantly only for SRT-TB (p = 0.025). Physical function decreased significantly 5 months after SRT-TB (p = 0.008). Future uncertainty worsened after RT, but significantly only for SRT-TB after 2 months (p = 0.036). Patients treated with WBRT had significant worsening of appetite, hair loss, and drowsiness after treatment.
Despite higher symptom burden after WBRT attributed to the side effects of RT (such as appetite loss, drowsiness, and hair loss), global health status, physical functioning, and future uncertainty favored WBRT compared with SRT-TB. This may be related to the compromised brain tumor control with omission of WBRT.
最近一项随机试验（NCT01535209）表明，在接受单一脑转移瘤切除的患者中，肿瘤床立体定向放射治疗（SRT-TB）与全脑放疗（WBRT）在神经认知功能方面无差异。与 WBRT 组相比，接受 SRT-TB 治疗的患者总生存时间更短。在此，我们比较了接受 WBRT 与 SRT-TB 的患者的健康相关生活质量（HRQOL）。
使用自我报告问卷（EORTC QLQ-C30 联合 QLQ-BN20 模块）在放疗前、放疗后 2 个月以及此后每 3 个月评估 HRQOL。HRQOL 结果以平均评分表示，并在组间进行比较。
在 59 名随机患者中，有 37 名（64%）符合 HRQOL 分析的条件，其中 15 名接受 SRT-TB 治疗，22 名接受 WBRT。两组在总体健康状况和主要功能量表/症状（除了 WBRT 治疗后 2 个月的嗜睡和食欲下降）方面无差异。放疗后 2 个月和 5 个月时，总体健康状况下降，但仅 SRT-TB 有显著差异（p=0.025）。放疗后 5 个月时，身体功能显著下降（p=0.008）。未来不确定性在放疗后恶化，但仅 SRT-TB 在 2 个月后有显著差异（p=0.036）。接受 WBRT 治疗的患者在治疗后食欲下降、脱发和嗜睡显著恶化。
尽管 WBRT 治疗后的副作用（如食欲下降、嗜睡和脱发）导致症状负担增加，但与 SRT-TB 相比，WBRT 更有利于全球健康状况、身体功能和未来不确定性。这可能与省略 WBRT 导致的脑肿瘤控制受损有关。
